Individual
SHELLY ANN BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
401 W MARTINTOWN RD, NORTH AUGUSTA, SC 29841-3194
(803) 441-0025
Mailing address
401 W MARTINTOWN RD, NORTH AUGUSTA, SC 29841-3194
(803) 441-0025
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
558
SC
225200000X
Physical Therapy Assistant
PTA002163
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
558
SC LICNESE
SC
Enumeration date
03/06/2008
Last updated
03/06/2008
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